RN Case Manager
GENERAL SUMMARY
Care Manager/Denials and Appeals Nurse
Under the direction of the Director of Care Management, this position supports the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. This position is accountable for designed patient caseload and plans effectively in order to meet patients' needs, manage the length of stay, and promotes efficient utilization of resources. Must be able to use Excel Spreadsheets for reports.
Specific functions within this role include:
Collaborate with Hospitalists and other disciplines coordinating care to impact length of stay and case mix.
Manage discharge planning upon admission to develop a safe and appropriate transition to the next level of care.
Coordinating communication with physicians.
Understands clinical documentation efforts and supports accurate documentation.
Understands and identifies process improvement methodologies and evaluating outcomes of care.
Facilitation of pre-certification and payor authorization processes.
Demonstrates compliance with regulatory requirements.
8. Appeal all payer denials
9. Track Reimbursement and denied cases
10. Prepare Reports for Administrative Meetings Utilizing Excel Spreadsheet
11. Present Information during UM Meetings and other meetings as requested
MINIMUM QUALIFICATION
Education, Knowledge, Skills and Abilities
Degree in nursing required, BSN preferred. Required professional skills include data entry into and retrieval from a managed care information system, and ability to effectively interface with physicians.
Required Length and Type of Experience
Minimum of one year experience in a managed care setting preferred, and a minimum of three to five years medical nursing, surgical nursing and/or nursing in the acute care setting. Experience with Medical Appeals preferred.
Required Licensure or Certification
Current State of Ohio nursing license. Certification in Case Management (CCM) preferred.
Required Physical and Environmental Demands
Work and move among all acute care nursing units. Manual dexterity to operate personal computers and standard office machines. Flexible work hours required throughout the year. General office working conditions
Current ACMC Healthcare System employees
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
Care Manager/Denials and Appeals Nurse
Under the direction of the Director of Care Management, this position supports the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. This position is accountable for designed patient caseload and plans effectively in order to meet patients' needs, manage the length of stay, and promotes efficient utilization of resources. Must be able to use Excel Spreadsheets for reports.
Specific functions within this role include:
Collaborate with Hospitalists and other disciplines coordinating care to impact length of stay and case mix.
Manage discharge planning upon admission to develop a safe and appropriate transition to the next level of care.
Coordinating communication with physicians.
Understands clinical documentation efforts and supports accurate documentation.
Understands and identifies process improvement methodologies and evaluating outcomes of care.
Facilitation of pre-certification and payor authorization processes.
Demonstrates compliance with regulatory requirements.
8. Appeal all payer denials
9. Track Reimbursement and denied cases
10. Prepare Reports for Administrative Meetings Utilizing Excel Spreadsheet
11. Present Information during UM Meetings and other meetings as requested
MINIMUM QUALIFICATION
Education, Knowledge, Skills and Abilities
Degree in nursing required, BSN preferred. Required professional skills include data entry into and retrieval from a managed care information system, and ability to effectively interface with physicians.
Required Length and Type of Experience
Minimum of one year experience in a managed care setting preferred, and a minimum of three to five years medical nursing, surgical nursing and/or nursing in the acute care setting. Experience with Medical Appeals preferred.
Required Licensure or Certification
Current State of Ohio nursing license. Certification in Case Management (CCM) preferred.
Required Physical and Environmental Demands
Work and move among all acute care nursing units. Manual dexterity to operate personal computers and standard office machines. Flexible work hours required throughout the year. General office working conditions
Current ACMC Healthcare System employees
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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